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Evidence-based assessment/Oppositional defiant disorder (assessment portfolio)/extended version

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What is a "portfolio"?

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For background information on what assessment portfolios are, click the link in the heading above.

Does this page feel like too much information? Click here for the condensed version.

Preparation phase

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Diagnostic criteria for oppositional defiant disorder

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ICD-11 Diagnostic Criteria

General Description: Oppositional defiant disorder is a persistent pattern (e.g., 6 months or more) of markedly defiant, disobedient, provocative or spiteful behaviour that occurs more frequently than is typically observed in individuals of comparable age and developmental level and that is not restricted to interaction with siblings. Oppositional defiant disorder may be manifest in prevailing, persistent angry or irritable mood, often accompanied by severe temper outbursts or in headstrong, argumentative and defiant behaviour. The behavior pattern is of sufficient severity to result in significant impairment in personal, family, social, educational, occupational or other important areas of functioning

Oppositional Defiant Disorder With Chronic Irritability-Anger: All definitional requirements for oppositional defiant disorder are met. This form of oppositional defiant disorder is characterized by prevailing, persistent angry or irritable mood that may be present independent of any apparent provocation. The negative mood is often accompanied by regularly occurring severe temper outbursts that are grossly out of proportion in intensity or duration to the provocation. Chronic irritability and anger are characteristic of the individual’s functioning nearly every day, are observable across multiple settings or domains of functioning (e.g., home, school, social relationships), and are not restricted to the individual’s relationship with his/her parents or guardians. The pattern of chronic irritability and anger is not limited to occasional episodes (e.g., developmentally typical irritability) or discrete periods (e.g., irritable mood in the context of manic or depressive episodes).

  • Note: The ICD-11 lists 3 additional subcategories of oppositional defiant disorder with chronic irritability-anger (i.e., with limited prosocial emotions, with typical prosocial emotions, and unspecified). They can be found here.


Oppositional Defiant Disorder Without Chronic Irritability-Anger: Meets all definitional requirements for oppositional defiant disorder. This form of oppositional defiant disorder is not characterized by prevailing, persistent, angry or irritable mood, but does feature headstrong, argumentative, and defiant behavior.

  • Note: The ICD-11 lists 3 additional subcategories of oppositional defiant disorder without chronic irritability-anger (i.e., with limited prosocial emotions, with typical prosocial emotions, and unspecified). They can be found here.


Changes in DSM-5
The diagnostic criteria for ADHD changed slightly from DSM-IV to DSM-5. See the changes here.

[1]

Base rates of ODD in different clinical settings

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This section describes the demographic setting of the population(s) sampled, base rates of diagnosis, country/region sampled and the diagnostic method that was used. Using this information, clinicians will be able to anchor the rate of ODD that they are likely to see in their clinical practice.

  • To see prevalence rates across multiple disorders, click here.
Demography Setting Base Rate Diagnostic Method
Various locations across USA Meta-analysis of 38 studies[2] 3.3% Varied
All of the U.S. Nationally representative large-scale study (N = 3,119) [3] 10.2% (overall)

11.2% (males)

9.2% (females)

World Health Organization (WHO) Composite International Diagnostic Interview (CIDI)r
Suburban and urban Colorado Project to Learn about Youth-Mental health, school-based study for children from kindergarten to high-school (n = 236)[4] 6.8% Diagnostic Interview Schedule for Children (DISC)
Urban and suburban Florida Project to Learn about Youth-Mental health, school-based study for children from kindergarten to high-school (n = 289)[4] 6.9% Diagnostic Interview Schedule for Children (DISC)
Rural and suburban Ohio Project to Learn about Youth-Mental health, school-based study for children from elementary to high-school (n = 152)[4] 17.3% Diagnostic Interview Schedule for Children (DISC)
Suburban and rural South Carolina Project to Learn about Youth-Mental health, school-based study for children from elementary to high-school (n = 270)[4] 5.7% Diagnostic Interview Schedule for Children (DISC)
Semi-rural North Carolina Preschool-aged children from pediatric practices (N = 306; age 2 - 5 years old)[5] 6.6% Preschool Age Psychiatric Assessment (PAPA)p
Western North Carolina The Great Smoky Mountains Study - longitudinal, population-based study of community sample[6] 2.33% (overall)

3.16% (males) 2.75% (females)

Child and Adolescent Psychiatric Assessment (CAPA)p, y
Chicago Preschool-aged children from inner city schools and pediatric practices (N = 796; age 2 - 5 years old)[7] 8.3% Diagnostic Interview Schedule for Children–Parent Scale–Young Child Version (DISC-YC) p
Germany (Saarbrücken County) All school-aged children were examined during a routine school-entry medical examination (N = 1676, mean age = 5.7)[8] 7.3% (males)

5.1%(females)

DISYPS-II
South Korea (Seoul) Children were randomly surveyed across 6 school districts in Seoul (N = 1645, age 6 - 12 years old) 5.8% (males)

4.1%(females)

Diagnostic Interview Schedule for Children–Parent Scale IV (DISC-IV)

p Parent interviewed as part of diagnostic assessment; y youth interviewed as part of diagnostic assessment, r adult interviewed for retrospective report as part of diagnostic assessment

Note: Mash and Barkley note that prevalence rates of ODD must be qualified, because the definition of ODD has changed at a fast rate, the rates adolescents meeting criteria in any cross-sectional evaluation may be misleading because of the developmental progressions with and between ODD and Conduct Disorder, and categorical definitions of aggressive patterns may reflect arbitrary numbers of constituent estimates. These factors may lead to misleading prevalence rates. In addition, few studies have investigated the prevalence of ODD in preschool-aged children, and early onset of these behaviors is associated with more severe and stable impairment.[9]

Prediction phase

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The following section contains a list of screening and diagnostic instruments for ODD. The section includes administration information, psychometric data, and PDFs or links to the screenings.

  • Screenings are used as part of the prediction phase of assessment; for more information on interpretation of this data, or how screenings fit in to the assessment process, click here.
  • For a list of more broadly reaching screening instruments, click here.
Screening measures for ODD
Measure Format (Reporter) Age Range Administration/

Completion Time

Interrater Reliability Test-Retest Reliability Construct Validity Content Validity Highly Recommended Where to access
Achenbach System of Empirically Based Assessments (ASEBA): Child Behavior Checklist (CBCL) Parent report 6-18

[10]

10 - 15 minutes[10] A[11] E[11] E[11] G[11]
 
 Purchase
ASEBA: Teacher Report Form (TRF) Teacher report 6-18

[10]

10 - 15 minutes[10] A[11] E[11] E[11] G[11]
 
 Purchase
ASEBA: Youth Self-Report (YSR) Youth self-report 11-18

[10]

10 - 15 minutes[10] A[11] E[11] E[11] G[11]
 
 Purchase
Behavior Assessment for Children, Third Edition (BASC-3): Parent Rating Scale Parent report 2-21 10 - 20 minutes A[11] E[11] G[11] E[11]
 
 Purchase
BASC-3: Teacher Rating Scale Teacher report 2-21 10 - 20 minutes A[11] E[11] G[11] E[11]
 
 Purchase
BASC-3: Self-Report of Personality


Youth self-report 6 - college age 30 minutes A[11] E[11] G[11] E[11]
 
 Purchase
Eyberg Child Behavior Inventory (ECBI) Parent report 2-16 5 minutes A[11] G[11] E[11] E[11]
 
 Purchase
Sutter-Eyberg Student Behavior Inventory - Revised (SESBI-R) Teacher report 2-16 5 minutes A[11] G[11] E[11] E[11]
 
 Purchase
Child and Adolescent Behavior Inventory (CABI) Parent Report 3 - 18 5 - 10 minutes A[12] PDF
Strengths and Difficulties Questionnaire (SDQ) Parent report 3 - 16 3 - 5 minutes E[13] G[13] SDQ HomepagePDFs

-Strengths and Difficulties Questionnaire for parents or educators of 2-4 year olds Assessment Center Link

-Strengths and Difficulties Questionnaire for parents or teachers of 4-10 year olds Assessment Center Link

-Strengths and Difficulties Questionnaire for parents or teachers of 11-17 year olds Assessment Center Link

-Strengths and Difficulties Questionnaire (Child Self-Report) [age 11-17] Assessment Center Link

-Strengths and Difficulties Questionnaire for self-report by those aged 18+ Assessment Center Link

-Strengths and Difficulties Questionnaire for informant report on those aged 18+ Assessment Center Link

Disruptive Behavior Disorder Rating Scale Parent report, teacher report 5 - 17 5 - 10 minutes PDF

Note: L = Less than adequate; A = Adequate; G = Good; E = Excellent; U = Unavailable; NA = Not applicable

Likelihood ratios and AUCs of screening instruments for ODD

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  • For a list of the likelihood ratios for more broadly reaching screening instruments, click here.
Screening Measure (Primary Reference) Area Under Curve (AUC) LR+ (Score) LR- (Score) Clinical Generalizability Where to Access
CBCL DSM-Oriented Scales[14] .71 (N=475)[15] 2.80 (60+ to 70+) [16] .52 (60- to 70-)*[16] Youth aged 5 - 18 seeking out patient treatment across a variety of settings[16] Purchase
SDQ[17] .81 -.88 (N = 18,416)[18] 7.00 [16] .55[16] Youth aged 5 - 18 seeking out patient treatment across a variety of settings[16] SDQ HomepagePDFs
SDQ - DSM -IV Conduct and ODD 7.55 (3+)[19] .35 (3-)[19] Surveyed youth aged 5 - 15 in the UK [19] SDQ HomepagePDFs
ECBI- Intensity Scale[20] 6.92 (131+)[21] .11 (131-)[21] Youth aged 7-16 had responses compared to diagnosis[21] Purchase
BASC-2 PRS - Aggression .76 (N =156)[22] 3.62 (65+)[22] .60 (65-)[22] Youth from first through fourth grade who were at risk for CD[22] Purchase

Note: “LR+” refers to the change in likelihood ratio associated with a positive test score, and “LR-” is the likelihood ratio for a low score. Likelihood ratios of 1 indicate that the test result did not change impressions at all. LRs larger than 10 or smaller than .10 are frequently clinically decisive; 5 or .20 are helpful, and between 2.0 and .5 are small enough that they rarely result in clinically meaningful changes of formulation[23].

Search terms: [Oppositional Defiant Disorder] AND [sensitivity OR specificity] in GoogleScholar and PsychINFO;

Interpreting ODD screening measure scores

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  • For information on interpreting screening measure scores, click here.

Prescription phase

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Gold standard diagnostic interviews

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  • For a list of broad reaching diagnostic interviews sortable by disorder with PDFs (if applicable), click here.
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Diagnostic instruments for ODD
Measure Format (Reporter) Age Range Administration/

Completion Time

Interrater Reliability Test-Retest Reliability Construct Validity Content Validity Highly Recommended Where to Access
Kiddie Schedule for Affective Disorders and Schizophrenia Present and Lifetime Version (KSADS-PL) Structured interview 6-28 45-75 minutes E[24] G[24] Website to access
Diagnostic Interview Schedule for Children (DISC-5) Structured Interview (Self report and parent) 6-17 [11]
 
 Coming soon

Note: L = Less than adequate; A = Adequate; G = Good; E = Excellent; U = Unavailable; NA = Not applicable

Process phase

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The following section contains a list of process and outcome measures for oppositional defiant disorder. The section includes benchmarks based on published norms for several outcome and severity measures, as well as information about commonly used process measures. Process and outcome measures are used as part of the process phase of assessment. For more information of differences between process and outcome measures, see the page on the process phase of assessment.

Outcome and severity measures

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  • This table includes clinically significant benchmarks for generalized anxiety disorder specific outcome measures
  • Information on how to interpret this table can be found here.
  • Additionally, these vignettes might be helpful resources for understanding appropriate adaptation of outcome measures in practice.
  • For clinically significant change benchmarks for the CBCL, YSR, and TRF total, externalizing, internalizing, and attention benchmarks, see here.
Measure Subscale Cut-off scores Critical Change
(unstandardized scores)
Benchmarks Based on Published Norms
A B C 95% 90% SEdifference
CBCL T-scores
(2001 Norms) 		Externalizing 49 70 58 7 6 3.4
ECBI Scaled Scores
(1983 Norms) 		Intensity 80.1 169.5 112.9 9.5 8 4.8
ECBI Scaled Scores
(1983 Norms) 		Problem 3.9 17.7 11.5 2.1 1.8 1.1

Note: “A” = Away from the clinical range, “B” = Back into the nonclinical range, “C” = Closer to the nonclinical than clinical mean.

Process measures

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See Section 1.1 for overview of evidence-based measures to use depending on etiology and symptomatology of Oppositional Defiant Disorder.

Treatment

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Behavioral parent training

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Behavioral Parent Training is considered the most effective treatment for childhood disruptive behavior disorders (e.g., Oppositional Defiant Disorder), especially for younger children (i.e., 3-8 year-olds). See http://effectivechildtherapy.org/concerns-symptoms-disorders/disorders/rule-breaking-defiance-and-acting-out/ a website sponsored by The Society for Child and Adolescent Psychology (APA, Division 53) and the Association for Behavioral and Cognitive Therapies (ABCT), for current summary of evidence-based treatments.

Overview of recommendations for assessment and treatment

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See the National Institute for Health and Care Excellence (NICE) Practice Guidelines for Childhood Conduct Disorders, for an overview of recommendations for both assessment and treatment of Oppositional Defiant Disorder.

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References

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Click here for references
  1. ↑ "ICD-11 for Mortality and Morbidity Statistics". icd.who.int. Retrieved 2022-07-11.
  2. ↑ Canino G, Polanczyk G, Bauermeister JJ, et al. (2010) Does the prevalence of CD and ODD vary across cultures? Social Psychiatry Epidemiology, 45(7):695–704.
  3. ↑ Nock, M. K., Kazdin, A. E., Hiripi, E., & Kessler, R. C. (2007). Lifetime prevalence, correlates, and persistence of oppositional defiant disorder: results from the National Comorbidity Survey Replication. Journal of Child Psychology and Psychiatry, 48(7), 703-713.
  4. ↑ 4.0 4.1 4.2 4.3 Danielson, Melissa L.; Bitsko, Rebecca H.; Holbrook, Joseph R.; Charania, Sana N.; Claussen, Angelika H.; McKeown, Robert E.; Cuffe, Steven P.; Owens, Julie Sarno et al. (2021-06-01). "Community-Based Prevalence of Externalizing and Internalizing Disorders among School-Aged Children and Adolescents in Four Geographically Dispersed School Districts in the United States". Child Psychiatry & Human Development 52 (3): 500–514. doi:10.1007/s10578-020-01027-z. ISSN 1573-3327. PMID 32734339. PMC PMC8016018. https://doi.org/10.1007/s10578-020-01027-z. 
  5. ↑ Egger, H.L., & Angold, A. (2006). Common emotional and behavioral disorders in preschool children: Presentation, nosology, and epidemiology. Journal of Child Psychiatry and Psychology, 47, 313–337.
  6. ↑ Costello, E. J., Mustillo, S., Erkanli, A., Keeler, G., & Angold, A. (2003) Prevalence and development of psychiatric disorders in adolescence. Arch Gen Psychiatry, 60, 837-844.
  7. ↑ Lavigne, J. V., LeBailly, S. A., Hopkins, J., Gouze, K. R., & Binns, H. J. (2009). The prevalence of ADHD, ODD, depression, and anxiety in a community sample of 4-year-olds. Journal Of Clinical Child And Adolescent Psychology, 38(3), 315-328. doi:10.1080/15374410902851382
  8. ↑ Niemczyk, Justine; Equit, Monika; Braun-Bither, Katrin; Klein, Anna-Maria; von Gontard, Alexander (2015-07-01). "Prevalence of incontinence, attention deficit/hyperactivity disorder and oppositional defiant disorder in preschool children". European Child & Adolescent Psychiatry 24 (7): 837–843. doi:10.1007/s00787-014-0628-6. ISSN 1435-165X. https://doi.org/10.1007/s00787-014-0628-6. 
  9. ↑ Mash, E., & Barkley, R. (Eds.). (2003). Child Psychopathology. 2nd Edition. New York: Guilford Press.
  10. ↑ 10.0 10.1 10.2 10.3 10.4 10.5 Assessment of disorders in childhood and adolescence. Eric Arden Youngstrom, Mitchell J. Prinstein, Eric J. Mash, Russell A. Barkley (Fifth edition ed.). New York, NY. 2020. ISBN 978-1-4625-4363-2. OCLC 1130319849. https://www.worldcat.org/oclc/1130319849. 
  11. ↑ 11.00 11.01 11.02 11.03 11.04 11.05 11.06 11.07 11.08 11.09 11.10 11.11 11.12 11.13 11.14 11.15 11.16 11.17 11.18 11.19 11.20 11.21 11.22 11.23 11.24 11.25 11.26 11.27 11.28 11.29 11.30 11.31 11.32 Hunsley, John; Mash, Eric J. (2008). A guide to assessments that work. New York: Oxford University Press. ISBN 9780195310641. OCLC 314222270. https://www.worldcat.org/oclc/314222270. 
  12. ↑ Burns, G. Leonard; Preszler, Jonathan; Becker, Stephen P. (2022-07-04). "Psychometric and Normative Information on the Child and Adolescent Behavior Inventory in a Nationally Representative Sample of United States Children". Journal of Clinical Child & Adolescent Psychology 51 (4): 443–452. doi:10.1080/15374416.2020.1852943. ISSN 1537-4416. PMID 33428463. PMC PMC8272731. https://doi.org/10.1080/15374416.2020.1852943. 
  13. ↑ 13.0 13.1 Goodman, Robert (2001-11-01). "Psychometric Properties of the Strengths and Difficulties Questionnaire". Journal of the American Academy of Child & Adolescent Psychiatry 40 (11): 1337–1345. doi:10.1097/00004583-200111000-00015. ISSN 0890-8567. PMID 11699809. https://www.jaacap.org/article/S0890-8567(09)60543-8/abstract. 
  14. ↑ Achenbach, T. M. (1991a). Manual for the Child Behavior Checklist/4–18 and 1991 Profile. Burlington , VT : University of Vermont Department of Psychiatry.
  15. ↑ Ebesutani, C., Bernstein, A., Nakamura, B. J., Chorpita, B. F., Higa-McMillan, C. K., & Weisz, J. R. (2010). Concurrent validity of the child behavior checklist DSM-oriented scales: Correspondence with DSM diagnoses and comparison to syndrome scales. Journal of Psychopathology and Behavioral Assessment, 32(3), 373-384.
  16. ↑ 16.0 16.1 16.2 16.3 16.4 16.5 Warnick, E. M., Bracken, M. B., & Kasl, S. (2008). Screening efficiency of the Child Behavior Checklist and Strengths and Difficulties Questionnaire: a systematic review. Child and Adolescent Mental Health, 13(3), 140-147.
  17. ↑ Shabani, Amir; Masoumian, Samira; Zamirinejad, Somayeh; Hejri, Maryam; Pirmorad, Tahereh; Yaghmaeezadeh, Hooman (2021-05). "Psychometric properties of Structured Clinical Interview for DSM‐5 Disorders‐Clinician Version (SCID‐5‐CV)". Brain and Behavior 11 (5). doi:10.1002/brb3.1894. ISSN 2162-3279. PMID 33729681. PMC PMC8119811. https://onlinelibrary.wiley.com/doi/10.1002/brb3.1894. 
  18. ↑ Algorta, Guillermo Perez; Dodd, Alyson Lamont; Stringaris, Argyris; Youngstrom, Eric A. (2016-09). "Diagnostic efficiency of the SDQ for parents to identify ADHD in the UK: a ROC analysis". European Child & Adolescent Psychiatry 25 (9): 949–957. doi:10.1007/s00787-015-0815-0. ISSN 1018-8827. PMID 26762184. PMC PMC4990620. http://link.springer.com/10.1007/s00787-015-0815-0. 
  19. ↑ 19.0 19.1 19.2 Goodman, Robert (2001-11-01). "Psychometric Properties of the Strengths and Difficulties Questionnaire". Journal of the American Academy of Child & Adolescent Psychiatry 40 (11): 1337–1345. doi:10.1097/00004583-200111000-00015. ISSN 0890-8567. PMID 11699809. https://www.jaacap.org/article/S0890-8567(09)60543-8/abstract. 
  20. ↑ Eyberg, S. M., & Robinson, E. A. (1983). Conduct problem behavior: Standardization of a behavioral rating scale with adolescents. Journal of Clinical Child Psychology, 12 (3), 347-354.
  21. ↑ 21.0 21.1 21.2 LYNEHAM, HEIDI J.; ABBOTT, MAREE J.; RAPEE, RONALD M. (2007-06). "Interrater Reliability of the Anxiety Disorders Interview Schedule for DSM-IV: Child and Parent Version". Journal of the American Academy of Child & Adolescent Psychiatry 46 (6): 731–736. doi:10.1097/chi.0b013e3180465a09. ISSN 0890-8567. https://doi.org/10.1097/chi.0b013e3180465a09. 
  22. ↑ 22.0 22.1 22.2 22.3 Doyle, Alysa; Ostrander, Rick; Skare, Stacy; Crosby, Ross D.; August, Gerald J. (1997-09-01). "Convergent and criterion-related validity of the behavior assessment system for children-parent rating scale". Journal of Clinical Child Psychology 26 (3): 276–284. doi:10.1207/s15374424jccp2603_6. ISSN 0047-228X. PMID 9292385. https://doi.org/10.1207/s15374424jccp2603_6. 
  23. ↑ Sackett, D. L., Straus, S. E., Richardson, W. S., Rosenberg, W., & Haynes, R. B. (2000). Evidence-based medicine: How to practice and teach EBM. Edinburgh: Churchill Livingstone.
  24. ↑ 24.0 24.1 KAUFMAN, JOAN; BIRMAHER, BORIS; BRENT, DAVID; RAO, UMA; FLYNN, CYNTHIA; MORECI, PAULA; WILLIAMSON, DOUGLAS; RYAN, NEAL (1997-07). "Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version (K-SADS-PL): Initial Reliability and Validity Data". Journal of the American Academy of Child & Adolescent Psychiatry 36 (7): 980–988. doi:10.1097/00004583-199707000-00021. ISSN 0890-8567. https://doi.org/10.1097/00004583-199707000-00021. 
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